- Evolent (Harrisburg, PA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Penn Medicine (Lancaster, PA)
- …and that established outcomes are achieved through availability and appropriated utilization of human, material and financial resources. + Educates patients and ... process improvement activities with an emphasis on increasing continuity in the nurse to patient relationship, minimizing rework and redundancies + constantly seeks… more
- Fresenius Medical Center (Pittsburgh, PA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- UPMC (Pittsburgh, PA)
- …Pennsylvania. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers ... Are you a registered nurse with a background in utilization ...Coordinates with Health Plan case managers or health management staff members to follow-up after discharge from an inpatient… more
- ChenMed (Philadelphia, PA)
- …record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible reduction ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...required + A minimum of one (1) year of utilization review and/or case management, home health,… more
- Guthrie (Sayre, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration...in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to… more
- WellSpan Health (York, PA)
- …goals, and proper utilization of services. * Provides after-hours and on-call staff support as well as visits and consultation on a scheduled, rotating basis. ... quality score ratings and rehospitalization rates. * Monitors productivity of respective staff and provides additional guidance when staff fall below… more
- Highmark Health (Pittsburgh, PA)
- …changes, regulatory requirements, etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages… more
- YesCare Corp (Philadelphia, PA)
- …Engage in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review :** Participate actively in utilization review ... justifications for non-formulary medication requests when necessary. + **Resource Utilization :** Resolve patient care issues using in-house resources before… more
- Penn Medicine (Philadelphia, PA)
- …devising strategies for minimizing expense variances. + Manages inventory through reagent utilization analysis. + Ensures all staff involved in moderately ... improve communication and to build productive relationships + Continuously communicates to staff the importance of patient satisfaction, quality of care, and sound… more